Emergency powers and the pandemic: Reflecting on state legislative reforms and the future of public health response.

The first 2 years of combatting the COVID-19 pandemic necessitated an unprecedented use of emergency powers. States responded with an equally unprecedented flurry of legislative changes to the legal underpinnings of emergency response and public health authorities. In this article, we provide a brief background on the framework and use of governors and state health officials' emergency powers. We then analyze several key themes, including both the enhancement and restriction of powers, emerging from emergency management and public health legislation introduced in state and territorial legislatures. During the 2020 and 2021 state and territorial legislative sessions, we tracked legislation related to the emergency powers of governors and state health officials. Legislators introduced hundreds of bills impacting these powers, some enhancing and others restricting emergency powers. Enhancements included increasing vaccine access and expanding the pool of eligible medical professions that could administer vaccinations, strengthening public health investigation and enforcement authority for state agencies, and preclusion of local orders by orders at the state level. Restrictions included establishing oversight mechanisms for executive actions, limits on the duration of the emergency, limiting the scope of emergency powers allowed during a declared emergency, and other restraints. By -describing these legislative trends, we hope to inform governors, state health officials, -policymakers, and emergency managers about how changes in the law may impact future public health and emergency response capabilities. Understanding this new legal landscape is critical to effectively preparing for future threats.

Trends in prematurity: what do changes at an urban institution suggest about the public health impact of 17-alpha hydroxyprogesterone caproate?

Despite the introduction of 17-alpha-hydroxyprogesterone caproate (17P), the national preterm birth (PTB) rate remains unchanged. Our objectives were to determine whether the overall rate of PTB has decreased and whether there has been a shift in the trends of prematurity at our institution since the initiation of 17P use. We performed a cross sectional study of the PTB rate and gestational age distribution at delivery (GA-del) at our institution over two, 2-year time periods: TP1 (pre 17P, 1 Jan 2004-31 Dec 2005) and TP2 (post 17P, 1 Jan 2008-31 Dec 2009). Statistical analyses included χ(2) tests for categorical data, t-tests for continuous data, and multivariable logistic regression to control for confounders. Overall (n = 15,421), there was no difference in the rate of PTB from TP1 to TP2 (16.65 vs 16.95%, p = 0.62). Among those with a history of prior PTB (n = 2,141), the mean preterm GA-del was 10 days later in TP2 than in TP1 (33.13 vs 31.64 weeks, p < 0.01) and significantly more preterm infants in TP2 delivered between 34-36 6/7 weeks than in TP1 (65.00 vs 45.63%, p < 0.01). The odds of a preterm infant delivering in the late preterm period was 2.3-fold higher in TP2 than TP1 (95% CI 1.49-3.54) after controlling for confounders. The significant shift in GA-del towards the late preterm period in TP2 may be due to the introduction of 17P use at our institution. Additional studies are needed to determine whether these trends persist on a nationwide level.

A case series of unilateral orbital aspergillosis in three cats and treatment with voriconazole.

Feline orbital aspergillosis is increasingly described in the published reports and may be an emerging disease. Orbital mycotic infections were diagnosed in three cats with exophthalmos, significant dorso-temporal globe deviation and pronounced resistance to retropulsion. Advanced imaging was performed in all three cases to evaluate the extent of disease as well as to obtain guided orbital biopsies in two cases. Surgical intervention in the form of a lateral orbitotomy was pursued in the first case with the other two cases treated with enucleation or medical management alone. The available published reports concerning sino-orbital aspergillosis are reviewed. Oral therapy with a novel triazole, voriconazole, was instituted in two cases. Although voriconazole was apparently effective against the fungal organisms, it is also resulted in adverse reactions.

Developing and Maintaining an RDN-Led Bedside Feeding Tube Placement Program.

Registered dietitian nutritionists (RDNs), like other healthcare professionals, are often searching for ways to improve their skills and advance their practice. One way RDNs have expanded their skills is by learning to place small bowel feeding tubes (SBFTs). However, it is also important that staffing RDNs to place SBFTs makes sense for their institution and their patient population. Although it is unknown how many RDNs place SBFTs, feeding tube placements by RDNs have been in practice for almost 2 decades, and it is within the RDN scope of practice. This article is a review of the literature, including indications for SBFT, possible benefits of RDNs placing SBFTs, development and maintenance of an RDN-led SBFT program, and assessment of clinical and institutional outcomes for this procedure.

Efficacy and safety of once versus twice daily administration of methimazole in cats with hyperthyroidism.

OBJECTIVE: To determine whether once daily administration of methimazole was as effective and safe as twice daily administration in cats with hyperthyroidism. DESIGN: Randomized, nonblinded, clinical trial. ANIMALS: 40 cats with newly diagnosed hyperthyroidism. PROCEDURE: Cats were randomly assigned to receive 5 mg of methimazole, PO, once daily (n = 25) or 2.5 mg of methimazole, PO, twice daily (15). A complete physical examination, including measurement of body weight; CBC; serum biochemical analyses, including measurement of serum thyroxine concentration; and urinalysis were performed, and blood pressure was measured before and 2 and 4 weeks after initiation of treatment. RESULTS: Serum thyroxine concentration was significantly higher in cats given methimazole once daily, compared with cats given methimazole twice daily, 2 weeks (3.7 vs 2.0 micro +/- g/dL) and 4 weeks (3.2 vs 1.7 microg/dL) after initiation of treatment. In addition, the proportion of cats that were euthyroid after 2 weeks of treatment was lower for cats receiving methimazole once daily (54%) than for cats receiving methimazole twice daily (87%). Percentages of cats with adverse effects (primarily gastrointestinal tract upset and facial pruritus) were not significantly different between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that once daily administration of methimazole was not as effective as twice daily administration in cats with hyperthyroidism and cannot be recommended for routine use.

Perceived Impacts of a Public Health Training Center Field Placement Program among Trainees: Findings from a Small Group Externship Experience.

There is heightened interest in identifying the impact of the federally funded Public Health Training Center (PHTC) program. Although evaluation studies have been conducted of public health training in general, evaluations of PHTC programs are rare. Field placement components are congressionally mandated requirements of PHTCs. Field placements are typically intensive, supervised externships for students to gain public health experience with local health departments or non-profit organizations. We have found no published evaluations of PHTC field placement components. This may be because of their small size and unique nature. We designed and evaluated a 200-h field placement program at an established PHTC. The evaluation included pre/post surveys measuring public health core competencies, and post-experience interviews. We found significant increases in three competency domains among trainees: policy development and program planning, communication skills, and community dimensions of practice. These outcomes contribute to evidence based on the efficacy of PHTC field placement programs, and underscore their role in public health training.

Comparing postcesarean infectious complication rates using two different skin preparations.

OBJECTIVE: To estimate whether a new preoperative skin preparation protocol decreases postcesarean delivery infectious complications. METHODS: We performed a retrospective cohort study. A povidone-iodine (13%) scrub followed by povidone-iodine (10%) paint (SCRUB+PAINT) protocol was compared with standard paint alone (PAINT). Patients and outcomes were identified using diagnosis-related group and International Classification of Diseases, 9th Revision, Clinical Modification coding. Monthly infection rates before the new protocol (October 1, 2007-September 30, 2008) were compared with rates after the protocol (January 1, 2009-December 31, 2009). The primary and secondary outcomes were major puerperal infection and a composite of major puerperal infection and infectious wound complications. Poisson regression was used to model monthly infection rates over time while controlling for confounders known to contribute to infectious risk. RESULTS: Data from 2,143 patients (PAINT: n=1,139; SCRUB+PAINT: n=1,004) were included in the analysis. There was no significant secular trend of decreasing infections over time before initiating SCRUB+PAINT (P=.42). SCRUB+PAINT was associated with a decrease in major puerperal infection (3.4 compared with 5.4/100 cesarean deliveries, P=.03) and composite wound infection (5.5 compared with 7.8/100 cesarean deliveries, P=.03) compared with PAINT alone. SCRUB+PAINT resulted in a 38% reduction in major puerperal infection (incident rate ratio 0.62 [0.42-0.93], P=.02) and a 31% reduction in composite wound infection (incident rate ratio 0.69 [0.50-0.96], P=.03) after controlling for confounders and fluctuations in the rates over time. CONCLUSION: The SCRUB+PAINT protocol is associated with a decrease in the rate of postcesarean delivery infectious complications compared with using povidone-iodine topical paint alone.